Partnering for the future.
Buy now, long-term care providers know that managed care will change the way in which they do business - if it hasn't already. Long-term care providers planning to contract with managed care organizations and hospitals are discovering that they need a patient billing and accounting system that is flexible, will capture costs and charges, and will ensure them the ability to bill and collect accurately and in a timely manner.
At Diversified Health Services (DHS) we needed a software solution to meet these needs. DHS, as the largest contract provider of supportive management services to the long-term care industry, had demanding criteria: We needed flexibility without compromising accountability. We are working with 26 Medicaid programs, 17 Medicare Intermediaries and numerous commercial and managed care payers. Our greatest need was to have the ability to "program" the coverage and payment specifics of a payer's or patient's plan - and do it one time.
Our search disclosed that the system that seemed to best meet this need was developed by a company called Keane, Inc. With this system, as the individual charges come through, it is the computer - not the bookkeeper - that decides how to bill and record the charge. Being able to accurately capture charges and their associated cost (if desired) in this way ensures us that we have appropriately billed the payer and reported revenue accurately to our owners.
We found that retroactive changes, such as a change in payer, room rates, or patient pay amounts, was also simplified and accurately recorded by this system. The user enters the appropriate change and the system "unbills" the previously billed charges and "rebills" the new. "Traditional" adjustments - time-consuming and prone to error - should no longer be occurring in our facilities.
Attempting to customize the system to meet our particular needs, we worked with Keane in developing a "data synchronization" module. This will allow our facilities to add new patients, record transfers and bed changes (ADT transactions) and enter cash and ancillaries locally. This changed or added data will then be transferred to our corporate offices nightly using Remote Ware, a product from XcelleNet. Using this data synchronization module, we have distributed the processes to their actual points of occurrence, while still retaining the billing controls at our corporate offices. And we have avoided the high cost of a wide area network. Also, important to our data integration needs, the local software will transfer data to and from our clinical application via the standard HL-7 protocol that allows multiple systems to communicate.
While accounting and billing was the most important aspect in our selecting a new software package, building a database of relevant data ranked just as important to us. This will provide us with a database of key information to assist us in marketing, research and patient cost analysis.
As facilities customizing their own software solutions will likely discover, installation of a new system is a slow process. It will take us about 18 months to implement the new system in all of our facilities. We are still in the process of testing software changes with Keane, installing new computer equipment, training staff members who will assist in the implementation and making necessary changes in our day-to-day operations.
More on that last point: Long-term care providers who plan to replace their existing systems need to be aware that they need to look not just at replacing their billing software, but at changing the way they do business. They also need to urge software vendors to make changes, if necessary, such as meeting the industry's HL-7 standard for transferring data among systems (e.g., pharmacy, hospital, etc.). And they should be prepared to invest in staff trained to operate the system - even a small organization will need many types of expertise in systems implementation to develop their own sophisticated approach to managing the entire operation.
The investment involved is more than worthwhile. We all have to be able to operate our businesses accurately and with maximum efficiency to survive in today's long-term care environment.
Judy Ullery is President and Debbie Hoefler is Executive Vice President of the Management Division of ServiceMaster Diversified Health Services, Memphis, TN. For more information, (901) 624-1600.
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|Title Annotation:||Diversified Health Services and Keane Inc.|
|Date:||Oct 1, 1997|
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